Benefit Eligibility & Reimbursement Social Worker

Commonwealth of Massachusetts • Tewksbury, MA

4h • Onsite

About The Position

The Massachusetts Department of Public Health (DPH) at Tewksbury Hospital is seeking an experienced leader to serve as the Benefit Eligibility & Referral Social Worker Supervisor (BERS Social Worker C). In this role, you will lead a dedicated team responsible for helping patients and long-term care residents navigate complex financial, insurance, and public benefit programs that support access to essential healthcare services. This is a great opportunity for a collaborative professional who enjoys mentoring staff, improving processes, and solving complex eligibility and financial counseling challenges. You will work closely with interdisciplinary healthcare teams, hospital leadership, MassHealth, Social Security, and community partners to remove barriers to treatment, strengthen patient outcomes, and support efficient hospital operations. DPH offers a mission-driven environment where your leadership will directly improve the lives of vulnerable individuals while providing opportunities for professional growth, meaningful collaboration, and public service.

Requirements

• Knowledge of the methods and standards of general report writing.
• Ability to read, interpret, apply, and explain laws, rules, regulations, policies, procedures, specifications, standards, and guidelines governing assigned areas.
• Ability to gather information through questioning and by examining records and documents.
• Ability to conduct interviews effectively and professionally.
• Ability to accurately record information provided orally.
• Ability to communicate clearly and effectively, both orally and in writing.
• Ability to write concisely, express thoughts clearly, and develop ideas in logical sequence.
• Ability to maintain accurate and organized records.
• Ability to perform arithmetic computations with speed and accuracy.
• Ability to assemble items of information in accordance with established procedures.
• At least four years of full-time, or equivalent part-time, professional experience in social work or social casework, claims adjudication, job placement, recruitment, employment counseling, vocational or rehabilitation counseling, credit investigation, educational counseling, legal advocacy, or legal counseling.
• A Bachelor's or higher degree may be substituted for two years of the required experience on the basis of two years of education for one year of experience.
• One year of education equals 30 semester hours. Education toward a degree will be prorated on the basis of the proportion of the requirements actually completed.
• Based on assignment, travel may be required. Those employees who elect to use a motor vehicle for travel must have a current and valid Massachusetts Motor Vehicle Operator's license or the equivalent from another state.

Nice To Haves

• Experience supervising staff in a healthcare, hospital, long-term care, or human services setting.
• Strong knowledge of MassHealth/Medicaid, Medicare, commercial insurance, and benefit eligibility programs.
• Experience managing long-term care (LTC) MassHealth applications, renewals, and appeals.
• Familiarity with Social Security (SSI/SSDI), disability benefits, and other federal assistance programs.
• Experience interpreting and applying state and federal healthcare regulations, including HIPAA and eligibility requirements.
• Demonstrated ability to analyze complex financial or benefit eligibility cases and develop effective solutions.
• Experience collaborating with interdisciplinary healthcare teams to support patient care and discharge planning.
• Proficiency with electronic health records, eligibility verification systems, databases, and Microsoft Office applications, including Excel.
• Excellent leadership, communication, organizational, and customer service skills with a commitment to promoting equitable access to healthcare services.

Responsibilities

• Provides day-to-day supervision and guidance to Benefits Eligibility & Referral Social Worker (A/B) staff performing financial counseling, private-pay assessments, registration, insurance verification, and encounter billing.
• Monitors the timeliness and accuracy of financial counseling and private‑pay assessments, ensuring consistent use of the hospital sliding fee scale and clear documentation of financial recommendations.
• Oversees registration workflows for new and returning patients, verifying that demographic, contact, insurance, and guarantor information is properly collected and updated in applicable systems.
• Develops, implements, and maintains standardized processes, templates, and tracking tools for MassHealth LTC applications, renewals, and related activities to promote timeliness and consistency.
• Provides advanced consultation to staff on complex Social Security and federal benefit matters, including SSI/SSDI eligibility, overpayments, appeals, suspensions, and reinstatements.
• Designs and maintains department-level tracking systems (e.g., spreadsheets, databases, dashboards) to monitor MassHealth eligibility, applications in progress, SC‑1 activity, redeterminations, and key deadlines.
• Provides oversight and consultation on cases involving immigration status and USCIS processes, ensuring that staff appropriately identify immigration‑related barriers that affect benefits and discharge planning.
• Oversees staff review of Personal Needs Accounts (PNA) balances and asset levels to identify patients exceeding allowable benefit thresholds.
• Oversees staff management of SORB‑related requirements, including tracking of annual fees, reporting obligations, and documentation requirements for designated patients.
• Oversees staff completion of Disabled Persons Protection Commission (DPPC) reports, ensuring that mandated reporting requirements are understood and consistently met.

Benefits

• Comprehensive Benefits
• Outstanding suite of employee benefits that add to the overall value of your compensation package.
• Work experience that supports you, your loved ones, and your future.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level